Kindergarten Camp Registration
Heath Elementary School 2019
Child's Name *
Your answer
Parent Name(s) *
Your answer
Address *
Your answer
Phone Number- Home *
Your answer
Phone Number- Cell *
Your answer
Child's Date Of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
Primary Language *
Lives With *
Special Needs (medication, allergies, conditions)
Your answer
Emergency contact- other than parents *
Your answer
Emergency contact -phone number *
Your answer
Legally Restricted persons not able to pick up
Your answer
Permission to provide Emergency services if needed *
Name of Adult as Signature *
Your answer
Tshirt size of student *
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